Esophageal Disorders Program

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Esophageal Cancer

The two most common types of esophageal cancer are squamous cell carcinoma, most often occurring in the upper and middle portions of the esophagus, and adenocarcinoma, affecting the mucous-secreting cells in the lower portion near the stomach. Other rare forms of the disease include sarcoma, lymphoma, small cell carcinoma and spindle cell carcinoma. In addition, breast and lung cancers can metastasize (spread) to the esophagus.

Signs & Symptoms

Symptoms of esophageal cancer include:

Difficulty swallowing (dysphagia) is the most common symptom of esophageal cancer. It doesn't appear right away but only after a tumor has grown large enough to prevent food from passing normally.

Unintentional weight loss because of reduced eating due to difficulty swallowing.

Pain in the throat, midchest or between the shoulder blades.

Hoarseness, hiccups and sometimes vomiting of blood appear when cancer is quite advanced.

Risk Factors

Esophageal Cancer Risk Factors

Researchers have identified several factors that can lead to esophageal cancer, including:

Heavy alcohol consumption

Tobacco use

Barrett’s esophagus

Acid reflux

Diet — a diet low in fruits and vegetables appears to contribute to esophageal cancer. Especially implicated are diets lacking in vitamins A, C and B-1 (riboflavin). People with low levels of the mineral selenium have a higher risk of esophageal cancer than do people with normal blood-selenium levels. Because high doses of selenium can be toxic, experts recommend getting selenium from foods such as fish, whole-grain bread, Brazil nuts and walnuts rather than from supplements.

Obesity — having a body mass index greater than 25 has been linked to an increased risk of adenocarcinoma.

Tylosis — a rare inherited disorder in which excess skin develops on the soles of the feet and palms of the hands. Close to half the people with tylosis eventually develop esophageal cancer. A genetic defect appears to be responsible for both tylosis and the associated cancer.

Diagnosis

Diagnosis of Esophageal Cancer

Diagnosis is achieved through esophagoscopy and biopsy.

Once diagnosis has been established, accurate staging of the cancer is necessary in order to permit optimum therapeutic decision-making. We use endoscopic transesophageal ultrasound (EUS) to visualize tumor depth, surrounding lymph nodes, and the tumor's relationship to adjacent structures. In combination with PET (positron emission tomography) and CT scanning, EUS is highly effective in properly staging tumors of the esophagus.

Treatments

Endoscopic Mucosal Resection (EMR) and BARRX Balloon Ablation

Patients with very early cancers of the esophagus can be treated by a combination of minimally invasive techniques. In Endoscopic mucosal resection (EMR), the portion of the lining that is diseased is removed using an endoscopic procedure. EMR enables the endoscopist to take a sample of tissue for biopsy at the same time as it is being removed. BARRX ablation is a very specific type of ablation, in which heat energy is delivered in a precise and highly-controlled manner. In patients with small superficial cancers that have not yet penetrated deeply into the wall of the esophagus, these techniques can be curative, sparing the patient from more extensive surgery that is required when the tumor invades deeper into the wall of the esophagus.

Stents may also be used to enable patients with esophageal blockages to swallow.

Surgery

Patients with more advanced tumors are encouraged to undergo multimodality therapy with chemotherapy and radiation therapy followed by surgery. Preoperative therapy increases the likelihood of complete removal of the tumor, and increases cure rate.

We perform many of our esophageal resections for cancer using laparoscopy or thoracoscopy. These minimally invasive approaches can significantly reduce the post operative convalescence, and speed recovery. Most patients are candidates for minimally invasive esophagectomy,, but our considerable experience with open surgery enables us to select appropriate patients for minimally invasive procedures.

Radiation Oncology

Our radiation oncology colleagues offer sophisticated treatment technology for patients with esophageal cancer, including the placement of small catheters threaded to the site of the tumor to deliver a high dose of radiation. Radiation therapy may be used with curative intent or to relieve symptoms, such as an inability to swallow solid foods.